By Verena R. Cimarolli
The LTSS Center’s Verena Cimarolli offers a helpful guide to the research shared in the latest issue of Generations.
For some time now, researchers at the LTSS Center @UMass Boston, including myself, have been invested in evaluating intervention programs, offered by post-acute rehabilitation settings, which are designed to support older adults who live with alcohol and substance misuse issues, such as engaging in hazardous drinking.
Our research has produced promising results: older adults who participated in a substance use recovery program were more likely to be discharged home from post-acute care, compared to older adults who were eligible for the program and decided not to participate. The LTSS Center also created a toolkit based on this research for post-acute providers interested in implementing a substance abuse recovery program.
Alcohol and substance misuse in older adults is underdiagnosed and undertreated, and, therefore, overlooked. Yet, without access to necessary interventions, many older adults with substance misuse issues suffer severe negative consequences. These consequences include falls and fractures that can result from hazardous drinking.
I was delighted to discover that the most recent issue of the Generations journal focuses on substance use and abuse among older adults. The issue is extremely timely and needed—and it is right up our alley at the LTSS Center.
The winter issue of Generations aims to raise the awareness of aging services provides around substance use issues. It gives “information on approaches easily learned by care providers and designed to move education, detection, and interventions related to unhealthy substance use by older adults into mainstream care settings,” according to guest editors Madeline A. Naegle and Benjamin H. Han.
Several of the articles in this issue have special relevance to LeadingAge members and our work at the LTSS Center. Here’s an overview of the articles that stood out for me.
PREVALENCE OF SUBSTANCE USE DISORDER
An article by Carlos Blanco and Isabella Lennon provides an overview of the prevalence of substance use and substance use disorder (SUD) among older adults. If you are looking for good statistics, you will find them here, as well as in contributions by Deborah S. Finnell and by Alexis Kuerbis and Silke Behrendt.
Blanco and Lennon summarize reasons why it is hard for older adults to seek treatment for SUD. One of their conclusions is that recovery programs as a form of mental health service need to be integrated with general health services in order to reach and engage older adults in SUD treatment more effectively. That was actually one reason why the programs the LTSS Center researchers evaluated made the decision to offer a brief screening, intervention, and referral program for substance misuse for older adults in their post-acute rehabilitation settings.
BARRIERS FACED BY OLDER ADULTS IN POST-ACUTE CARE
An article by Rossana Lau-Ng, Hollis Day, and Daniel P. Alford tackles the job of describing the barriers faced by older adults with SUD in post-acute settings. Some of these barriers include:
- Regulatory restrictions: Skilled nursing settings must comply with restrictions on the use of medications in the treatment of opioid use disorder. For example, they are not allowed to prescribe methadone.
- Stigmatization: Research has shown that health care professionals may hold negative views of patients with SUD and may not be willing to admit these patients into post-acute care. I have not found this to be true with the programs we evaluated, but there may be a reluctance among some providers to admit SUD patients because of their complex care needs.
- Reimbursement: Medicare reimbursement is limited to an individual’s admitting condition. We evaluated one program that estimated it could cover the cost of hiring a substance abuse counselor because post-acute patients with substance use issues have more complex care needs and, therefore, their care yields higher Medicare reimbursement rates. The programs we evaluated were focused on screening, a brief counseling intervention, and community referral, not SUD treatment.
INTERVENTION APPROACHES TO SUBSTANCE MISUSE
Pamela Z. Cacchione’s contribution provides two interesting case studies that exemplify a team-based approach to treating substance misuse in older adults who are participants in the Program of All-Inclusive Care for the Elderly (PACE). The substance misuse issues are addressed with psychotherapy, medication-assisted treatment, and the use community-based resources.
Deborah S. Finnell’s article provides practical tips and techniques that providers can use to talk with older adults about their alcohol consumption, and to lead older adults along the path of harm reduction if their alcohol consumption is hazardous. The author suggests and discusses the use of the brief negotiated interview (BNI), which is a semi-structured, motivational interview that is considered to be a best practice for this type of person-centered conversation.
I was drawn to Thomas Babor’s article about the effective Screening, Brief Intervention and Referral to Treatment (SBIRT) programs because the LTSS Center studies interventions using this program. Babor describes the innovative techniques of SBIRT-Plus, which aim to bring more people into SBIRT and to export SBIRT services from the clinic to other care settings serving older adults, such as nursing homes, assisted living settings, and retirement communities.
One important feature of SBIRT is relevant to LeadingAge members: its delivery can be taught successfully to a range of health workers in these settings. Barbor’s how-to guide to implementing a SBIRT program in your care setting is a worthwhile read.
TELEHEALTH IN SUBSTANCE MISUSE INTERVENTIONS
Finally, Alexis Kuerbis and Silke Behrendt’s article stands out because it focuses on the use of telehealth in screening, counseling, and treatment of older adults with SUD. This is especially useful during the pandemic. The authors, for example, review different web-based substance abuse screening programs. These brief, short-term, and long-term interventions can be delivered using technology like video conferencing or smartphones. What I found particularly helpful is the article’s overview of the technology preferences of older adults.
Check out the winter issue of Generations. It offers tons of good information on how to support older adults with substance use issues and SUD.
Verena Cimarolli, Ph.D., is senior health services research associate in the Washington, DC, office of the LeadingAge LTSS Center @UMass Boston. Her research focuses on the psychosocial challenges faced by older adults with chronic illness, and strategies for supporting those adults and their families.